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National University Health System

Preventive Medicine Residency Program

Resident’s Handbook

2012-2013

NUHS Preventive Medicine July 2012

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Orientation Day 2011 of National Preventive Medicine Residency

Front Row (L-R)

Dr Fong Yuke Tien, Dr Gan Siok Lin, Dr Chew Ling, Dr Raymond Lim, Dr Olivia Teo, Dr Adelina Young, Prof David Koh, Prof Goh Kee Tai, Dr Benjamin Ng, Dr Jason Yap, Dr Winston Chin and Mr. Kenny Chiw Back Row (L-R)

Dr Judy Sng, Dr Jake Goh, Dr Joshua Wong, Dr Jeff Hwang, Dr Tan Xin Quan, Dr Alexander Gorny, Dr Matthias Toh, Dr Eugene Shum and Dr Hanley Ho


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Contents

Welcome and Introduction ............................................................................................................ 4

General Program Information ....................................................................................................... 5

Accreditation............................................................................................................................ 5

Contact Details ........................................................................................................................ 6

Program Details ............................................................................................................................. 8 Policies and Working Environment ........................................................................................... 11

Preventive Medicine Competencies ........................................................................................... 13

Preventive Medicine Competencies ....................................................................................... 13

Educational and Clinical Experience ...................................................................................... 13

A) Core Preventive Medicine Competencies ......................................................................... 14

B) Occupational Medicine Competencies .............................................................................. 15

C) Public Health and General Preventive Medicine Competencies ........................................ 15

Progression of Competencies ................................................................................................ 16

Residency Years .......................................................................................................................... 20

First Year (Clinical Rotations) ................................................................................................ 20

Second and Third Years (Practicum Years) ........................................................................... 20

Additional Learning Opportunities .......................................................................................... 22

Evaluation ..................................................................................................................................... 24

Evaluators and Assessment Methods .................................................................................... 24

Evaluation schedule and documentation ............................................................................... 26

Final summative evaluation ................................................................................................... 26

Clinical Competency Committee ............................................................................................ 26

Program Evaluation Committee ............................................................................................. 27

Resident’s Responsibilities ......................................................................................................... 28

Policies ......................................................................................................................................... 30

Photos of the Outward Bound Singapore .................................................................................. 30

Annexes ........................................................................................................................................ 34


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Welcome and Introduction

Welcome to the National University Health System Preventive Medicine Residency Program. This program is designed to equip you with the skills necessary to be a preventive medicine physician, and to contribute to the profession at the national and global levels. I hope that you will take this opportunity to learn from your patients, peers, and faculty members. This handbook is designed to give you an overview of the program and to guide you through the residency years. Please use this handbook as a frequent reference for the questions that will come up as you go through your training. This edition of the handbook has been updated to reflect changes that have been made to the program over the past year. The program and its curriculum have been enhanced over the past year based on input from ACGME-I, the MOH Resident Advisory Committee, faculty members and residents. Feel free to contact myself or any of the faculty members with any queries, and I wish you a fruitful training experience. Professor Lee Hin Peng Program Director Preventive Medicine Residency April 2012


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General Program Information Preventive medicine focuses on the health of individuals and defined populations in order to protect, promote, and maintain health and well-being; and prevent disease, disability, and premature death. The Preventive Medicine Residency Program in the National University Health System (NUHS) encompasses the previous public health and occupational medicine training programs in Singapore, and provides residents with the full suite of skills to be future leaders in the field. It is designed to create a foundation for excellence in preventive medicine care upon which lifelong learning may take place. The NUHS is the only sponsoring institution for preventive medicine training in Singapore, and as such, is a National Program. A diverse group of local institutions are part of the program as participating sites to provide training and employment opportunities for residents. The participating sites are:

• Agency for Integrated Care

• Communicable Disease Centre / Tan Tock Seng Hospital

• Health Promotion Board

• Eastern Health Alliance

• Ministry of Health

• Ministry of Manpower (Occupational Safety and Health Division)

• National Healthcare Group HQ

• National Healthcare Group Polyclinics

• National University Hospital System

• Singapore Armed Forces

• Singapore General Hospital

The Preventive Medicine Residency Program aims to equip residents with a sound and adequately broad foundation in preventive medicine. During the training program, rotations are performed in NUHS and the participating sites, which offer a wide spectrum of training within a nurturing environment under the close supervision and mentorship of distinguished and experienced faculty. Upon successful completion of the training program, the resident will be able to establish a fulfilling career in preventive medicine in the public sector, private sector, academia, NGOs or international health organizations.

Accreditation

The NUHS Preventive Medicine Residency Program is accredited by the Ministry of Health, Singapore and the Accreditation Council for Graduate Medical Education – International (ACGME-I).

NUHS holds the authority and responsibility for the oversight, administration and quality of the ACGME-I-accredited programs, even when education occurs at other sites. NUHS will assure compliance with ACGME-I Common, specialty/subspecialty-specific Program, and Institutional Requirements. NUHS has established and implemented policies and procedures regarding the quality of education and the work environment; in particular:

• Resident’s Contracts

• Grievance Procedures

• Disciplinary Procedures / Academic Probation


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Contact Details Program administration Mr. Kenny Chiw National University Health System 5 Lower Kent Ridge Road Kent Ridge Wing 2, Level 5, Singapore 119074 Tel: 6772 6396 Fax: 6775 6757 E-mail: [email protected]

Faculty Members Program Director Professor Lee Hin Peng E-mail: [email protected] Tel: 6516 4983 Associate Program Directors Agency for Integrated Care

Dr Jason Yap E-mail: [email protected]

Communicable Disease Centre / Tan Tock Seng Hospital

Dr Benjamin Ng E-mail: [email protected]

Health Promotion Board

Dr Chew Ling E-mail: [email protected]

Eastern Health Alliance Dr Eugene Shum E-mail: [email protected]

Ministry of Health

Prof Goh Kee Tai E-mail: [email protected]

Ministry of Manpower: Occupational Safety and Health Division

Dr Ho Sweet Far E-mail: [email protected]

National Healthcare Group HQ

A/Prof Heng Bee Hoon E-mail: [email protected]

National Healthcare Group Polyclinics & HQ

Dr Matthias Toh E-mail: [email protected]

National University Hospital System

Asst Prof Judy Sng Gek Khim E-mail: [email protected]

Singapore Armed Forces

A/Prof Vernon Lee E-mail: [email protected]

Singapore General Hospital

Dr Fong Yuke Tien E-mail: [email protected]


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Residency Advisory Committee (RAC) The Residency Advisory Committee (RAC) is appointed by MOH to oversee the training program. They replace the Specialist Training Committee since 15 Sep 2011. The RAC works with the Sponsoring Institution, Designated Institution Official and Program Director to ensure that the residency program is constantly aligned with requirements and standards set by ACGME-I, and the RAC, in consultation with SAB/MOH. The members of the Preventive Medicine RAC are as follows:

• Prof Chia Kee Seng (Chairman)

• A/Prof Adeline Seow

• A/Prof Lee Hock Siang

• A/Prof Derrick Heng

• Dr Jason Cheah

• Dr Lee Chien Earn

• A/Prof Mabel Yap

• Dr Richard Tan

• A/Prof Chew Suok Kai


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Program Details Appointment as Residents Medical graduates can apply to enter Year 1 (R1) of the Preventive Medicine Residency program. Residency Program The Preventive Medicine Residency Program is a 5-year program comprising (a) 3-year Residency and (b) 2-year Advanced Practicum. The minimal duration of the training for exit certification as a specialist is therefore 5 years. The objective of the Residency Program is to equip residents with a sound and broad foundation, directed towards the acquisition of a core set of preventive medicine competencies, skills, and knowledge, based on theory and practical experience. This is necessary for residents to function effectively in the future as preventive medicine physicians, and to protect and promote the health of individuals and the population. The 3-year Residency includes:

• 12 months of general clinical experience (clinical year)

• 24 months of core preventive medicine rotations, which includes 9 months of preventive medicine clinical experience (basic practicum years)

Residents must, in addition to the above, successfully complete a Master of Public Health (MPH) or equivalent degree, before they are eligible to sit for the intermediate examination. When they pass the intermediate examination, they may move on to the advanced practicum stage.

Intermediate Exam

The intermediate exam consists of two components:

(a) Objective Structured Clinical Examination (OSCE) 4 Stations, 30 minutes each

• Multiple Choice Questions,

• Writing Policy Brief,

• Data Presentation, and

• Role-play.

(b) Viva voce Examination

• Based on any of the 4 stations

• General interview

The candidate must pass all cases. If the candidate does not pass the exam, he will have to retake all sections at the next attempt. The exam is conducted biannually and a candidate is allowed a maximum of 3 attempts.


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Master of Public Health

A resident may obtain the Master of Public Health through:

(a) The part-time MPH program at the Saw Swee Hock School of Public Health, National University of Singapore during R2 and R3; or

(b) A year out of the program can be taken after the first year to pursue a full-time MPH overseas.

Advanced Practicum

The advanced practicum phase focuses on developing skills in a specific specialty area of preventive medicine. The advanced practicum must include at least 6 months of training experience outside the main training site. This may be in the form of attachments locally or overseas and may include additional didactic courses or modules.

Completion of the advanced practicum phase and passing the final exit examination will qualify the individual as a Specialist by the Specialist Accreditation Board, Ministry of Health, and registration as a Specialist by the Singapore Medical Council.

A Resident’s Journey Residency Year 1 (R1)

Clinical year For PGY1, rotations must include: (a) Internal Medicine (4 months) (b) General Surgery or Orthopaedic Surgery (4 months)

In-training examination (every year during basic practicum)

Residency Year 2 (R2)

Basic practicum Rotations must include: (a) 6 months direct patient care in a primary care facility (b) 3 months direct patient care in an infectious disease department (c) 3 months attachment at a governmental public health agency (e.g. Ministry of Health or Ministry of Manpower)

Residency Year 3 (R3)

• A resident must complete R1-R3 and the Master of Public Health to be eligible for the Intermediate Examination

• Upon completion of the Intermediate Examination, a resident may progress to the Advanced Practicum

Advanced Practicum Year 1

Postings depending on areas of specialisation The Advanced Practicum must include at least 6 months of training experience outside the main training site. Advanced

Practicum Year 2 Exit examination as Specialist in Public Health or Occupational

Medicine


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Residency Rotations For residents entering the program in post-graduation year 1 (PGY1), during Residency Year 1, a typical resident’s rotation will include 4 months in Medicine, 4 months in Surgery or Orthopedic Surgery, and the last 4 months in an elective clinical rotation such as Pediatrics. For residents entering the program after PGY1, the Residency Year 1 would comprise of two 6-month rotations. During Residency Years 2 and 3, residents will be exposed to a wide range of basic practicum experiences within the participating institutions. They will receive a gradation in responsibility and competency as they progress from one residency year to the next. Required rotations during the practicum years are as follows:

• 6 months direct patient care in a primary care facility

• 3 months direct patient care in an infectious disease department

• 3 months attachment at a governmental public health agency (e.g. Ministry of Health or Ministry of Manpower)

As the training requirements for each resident is unique, the rotations will be tailored for every resident in consultation with the Program Director and the Associate Program Directors. In-training examination The in-training examination (ITE) will be conducted annually for Residents in the basic practicum years. The format of the examinations will be Multiple Choice Questions (MCQ), Written Questions and scientific paper critique. Lectures and Seminars During the course of the program, training sessions consisting of Preventive Medicine Grand Round, seminars and tutorials will be organized for residents. These training sessions will cover the competencies required of the resident in the various stages of the program. Residents are required to attend these training sessions as stipulated. Mentorship Every resident will be assigned a mentor. The mentor and resident are encouraged to meet regularly. The mentor will offer advice, provide information, and help to interpret institutional and department policies. The mentor will also guide the residents in term of career development and appointment.


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Policies and Working Environment for Residents Duty hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. The duty hour guidelines are very much in tandem with patient safety protocol too. Residents need to take personal responsibility of their own duty hour requirements and engage their supervisors accordingly should there be a breach. Duty hours do not include reading and preparation time spent away from the duty site. The following institutional policies apply to all NUHS programs and residents: 1) Duty hours must be limited to 80 hours, averaged over a 4-week period per rotation or a 4-week period within a rotation, inclusive of all in-house call activities, excluding vacation or approved leave. Any requests for exceptions to the weekly limit on duty hours must be presented by the Program Director to the GMEC for review and approval. 2) Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. 1 day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. 3) Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call. 4) Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements. 5) No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty. 6) Program Directors and Coordinators are responsible for monitoring and enforcing compliance with duty hours. B. Oversight and Monitoring of Duty Hours and the Work Environment For proper oversight, the Graduate Medical Education Committee (GMEC) has mandated that residents log and approve their duty hours on all rotations using the IT platform - New Innovations. The GME Office will generate a list of residents who are not logging the required information into New Innovations each month and provide a copy to the Program Director and Coordinator. If a resident does not comply with logging duty hours, the Program Director will begin proceedings to issue a written warning and the resident may be suspended from clinical activities. The Program Director will have 5 working days to get the resident in compliance with the requirement before a wr i t ten warning and possible suspension is activated. If the resident disagrees with the recommended action, the resident has access to the grievance process outlined in the grievance policy. 1. The Program Director must review the duty hours of all residents on all rotations within their program each month to ensure compliance with the duty hour rules. When a program is not operating within the duty hour requirements, the Program Director, in conjunction with the residents and appropriate faculty, must develop and implement a plan for


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corrective action, for any rotation not in compliance with the duty hour rules, or otherwise identified as problematic. If the issue cannot be resolved at the program level, it is escalated to the DIO for arbitration or if additional resources are required at the institution level. These issues will also be surfaced at the GMEC for review. 2. The GMEC will evaluate each program’s compliance with the duty hour rules on a monthly basis and during the internal review process. Programs with non-compliance will need to submit action plan to the DIO office. 3. The DIO will report the results of the duty hour reports at the Organized Medical Staff Meeting for the SI and its participating institutions. 4. Residents may report violations of the duty hour rules through procedures established by each program and/or by calling the DIO or GME Office. All policies related to NUHS Residency Programs are available for reference at NUHS Residents Manual or click on http://www.nuhs.edu.sg/nuhsresidency/prospective-residents.html


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Competencies

Preventive Medicine Competencies The competencies for preventive medicine (in accordance with AGCME-I guidelines) are as follows: (A) Patient (population) care Residents must be able to provide population (patient) care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. (B) Medical knowledge Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.

(C) Practice-based learning and improvement Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. (D) Interpersonal and communication skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (E) Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (F) Systems-based practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Educational and Clinical Experience The educational and clinical experience has been structured to provide the preventive medicine competencies. It will be met through the various preventive medicine postings throughout residency training. The competencies that will be achieved are broadly grouped into: (A) Core preventive medicine (B) Occupational medicine (C) Public health and general preventive medicine Through each posting, residents will be exposed to a range of experiences and will meet the requirements of several competencies. Residents are expected to keep track of the competencies that they have met, as this will be reviewed during the assessment process for graduation from residency. Residents are, in addition, encouraged to explore other areas of


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preventive medicine that are not included in the list of competencies to further their training and experience.

(A) Core Preventive Medicine Competencies

1. Communication, program, and needs assessment

a. Communicate effectively with patients, families, and the public, as appropriate, across a

broad range of socioeconomic and cultural backgrounds

b. Communicate effectively with physicians, other health professionals, and health-related

agencies

c. Work effectively as a member or leader of a health care team or other professional group

d. Act in a consultative role to other physicians and health professionals

e. Maintain comprehensive, timely, and legible medical records, if applicable

f. Conduct program and needs assessments and prioritize activities using objective,

measurable criteria such as epidemiologic impact and cost-effectiveness

2. Computer applications relevant to preventive medicine

a. Use computers for word processing, reference retrieval, statistical analysis, graphic

display, database management, and communication

3. Interpretation of relevant laws and regulations

a. Identify and review relevant laws and regulations germane to the resident’s specialty

area and assignments

4. Identification of ethical, social, and cultural issues relating to public health and

preventive medicine

a. Recognize ethical, cultural, and social issues related to a particular issue and develop

interventions and programs that acknowledge and appropriately address the issues

5. Identification of organizational and decision-making processes

a. Identify organizational decision-making structures, stakeholders, style, and processes

6. Identification and coordination of resources to improve the community’s health

a. Assess program and community resources, develop a plan for appropriate resources,

and integrate resources for program implementation

7. Epidemiology and Biostatistics

a. Characterize the health of a community

b. Design and conduct an epidemiologic study

c. Design and operate a surveillance system

d. Select and conduct appropriate statistical analyses

e. Design and conduct an outbreak or cluster investigation

f. Translate epidemiological findings into a recommendation for a specific intervention

8. Management and Administration

a. Assess data and formulate policy for a given health issue

b. Develop and implement a plan to address a specific health problem

c. Conduct an evaluation or quality assessment based on process and outcome

performance measures

d. Manage the human and financial resources for the operation of a program or project


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9. Clinical Preventive Medicine

a. Develop, deliver, and implement, under supervision, appropriate clinical services for both

individuals and populations

b. Evaluate the effectiveness of clinical services for both individuals and populations

10. Occupational and Environmental Health

a. Assess and respond to individual and population risks for occupational and

environmental disorders

(B) Occupational Medicine Competencies

a. Manage the health status of individuals who work in diverse settings

b. Monitor/survey workforces and interpret monitoring/surveillance data for prevention of

disease in workplaces and to enhance the health and productivity of workers

c. Manage worker insurance documentation and paperwork, for work-related injuries that

may arise in numerous work settings

d. Recognize outbreak events of public health significance, as they appear in clinical or

consultation settings

e. Report outcome findings of clinical and surveillance evaluations to affected workers as

ethically required; advise management concerning summary (rather than individual)

results or trends of public health significance

(C) Public Health and General Preventive Medicine Competencies

1. Public Health Practice a. Monitor health status to identify community health problems b. Diagnose and investigate health problems and health hazards in the community c. Inform and educate populations about health issues d. Mobilize community partnerships to identify and solve health problems e. Develop policies and plans to support individual and community health efforts f. Enforce laws and regulations that protect health and ensure safety g. Link people to needed personal health services and ensure provisions of health care

when otherwise unavailable h. Ensure a competent public health and personal health care workforce i. Evaluate the effectiveness, accessibility, and quality of personal and population-based

health services j. Conduct research for innovative solutions to health problems

2. Clinical Preventive Medicine a. Acquire an understanding of primary, secondary, and tertiary preventive approaches to

individual and population-based disease prevention and health promotion b. Able to develop, implement, and evaluate the effectiveness of appropriate clinical

preventive services for both individuals and populations c. Design and conduct health and clinical outcomes epidemiologic studies

3. Health Administration

a. Design and use management information systems

b. Plan, manage, and evaluate health services to improve the health of a defined population

using quality improvement and assurance systems


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Progression of Competencies Residents will be required to demonstrate progression of competencies from R1 to R3. The competency-based goals and objectives for each year of training are listed below.

Year of training

Competency based goals and objectives

R1

Patients (Population) Care 1. Conduct program and needs assessments and prioritize activities using

objective, measurable criteria such as epidemiological impact and cost-effectiveness

2. Use computers for word processing, reference retrieval

3. Identify and review relevant laws and regulations pertinent to the resident’s

specialty area and assignments

4. Use epidemiology and biostatistics, including the ability to characterize the health of a community and design and conduct an epidemiological study

5. Practice occupational and environmental health, including being able to

assess and respond to individual and population risks for occupational and environmental disorders

6. Manage the health status of individuals who work in diverse work settings

7. Mitigate and manage medical problems of workers

8. Recognize outbreak events of public health significance, as they appear in

clinical or consultation settings

9. Recognize and evaluate potentially hazardous workplace and environmental conditions

10. Understand primary, secondary, and tertiary preventive approaches to

individual and population-based disease prevention and health promotion

11. Develop and implement effective and appropriate clinical preventive services for individuals and populations

Practice-Based Learning and Improvement

1. Identify strengths, deficiencies, and limits in one’s knowledge and expertise

2. Set learning and improvement goals

3. Identify and perform appropriate learning activities

4. Incorporate formative evaluation feedback into daily practice

5. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems

6. Use information technology to optimize learning


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Year of training


7. Participate in the education of patients, families, students, residents and other

health professionals

8. Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds

Interpersonal and Communication Skills

1. Communicate effectively with physicians, other health professionals, and health related agencies

2. Maintain comprehensive, timely, and legible medical records

Professionalism

1. Compassion, integrity, and respect for others

2. Responsiveness to patient needs that supersedes self-interest

3. Respect for patient privacy and autonomy

4. Accountability to patients, society and the profession Systems-based Practice

1. Work effectively in various health care delivery settings and systems relevant to their clinical specialty

2. Coordinate patient care within the health care system relevant to their clinical

specialty

3. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate

4. Advocate for quality patient care and optimal patient care systems

5. Work in inter-professional teams to enhance patient safety

6. Participate in identifying system errors

R2

Patient (Population) Care

1. Use computers for statistical analysis, graphic display, database

management, and communication

2. Recognize ethical, cultural, and social issues related to a particular issue and developing interventions and programs that acknowledge and appropriately address the issues

3. Identify organizational decision-making structures, stakeholders, style, and

processes


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Year of training


4. Use epidemiology and biostatistics, including the ability to design and operate a surveillance system; select and conduct appropriate statistical analyses; and design and conduct an outbreak or cluster investigation

5. Manage and administer, including the ability to assess data and formulate

policy for a given health issue and develop and implement a plan to address a specific health problem

6. Provide clinical preventive medicine, including the ability develop, deliver, and

implement, under supervision, appropriate clinical services for both individuals and populations, and evaluate the effectiveness of clinical services for both individuals and populations

7. Practice occupational and environmental health, including being able to

assess and respond to individual and population risks for occupational and environmental disorders

8. Assess safe and unsafe work practices and safeguard employees and others,

based on clinic and worksite experience

9. Recommend controls or programs to reduce exposures, and to enhance the health and productivity of workers

10. Report outcome findings of clinical and surveillance evaluations to affected

workers as ethically required; advise management concerning summary (rather than individual) results or trends of public health significance

Practice-based Learning and Improvement

1. Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement


1. Work effectively as a member or leader of a health care team or other professional group

Professionalism

1. Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Systems-based Practice

1. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate


3. Improve patient care quality

4. Implement potential systems solutions


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Year of training


R3

Patient (Population) Care

1. Use epidemiology and biostatistics, including the ability to translate epidemiological findings into a recommendation for a specific intervention

2. Manage and administer, including the ability to conduct an evaluation or

quality assessment based on process and outcome performance measures; and manage the human and financial resources for the operation of a program or project

3. Provide clinical preventive medicine, including the ability to evaluate the

effectiveness of clinical services for both individuals and populations

4. Monitor/survey workforces and interpret/monitor surveillance data for prevention of disease in workplaces and enhancing the health and productivity of workers

5. Manage worker insurance documentation and paperwork, for work-related

injuries that may arise in numerous work settings

6. Recommend controls or programs to reduce exposures, and to enhance the health and productivity of workers

7. Evaluate the effectiveness of appropriate clinical preventive services for both

individuals and populations

8. Design and conduct health and clinical outcomes studies Practice-based Learning and Improvement

1. Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement

Interpersonal and Communication Skill

1. Work effectively as a member or leader of a health care team or other professional group

2. Act in a consultative role to other physicians and health professionals

Systems-based Practice

1. Show sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

2. Incorporate considerations of cost awareness and risk-benefit analysis in

patient and/or population-based care as appropriate



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Residency Years First Residency Year (R1) - Clinical Rotations The first residency year is a clinical year. It encompasses 12 months of general clinical experience. For residents entering the program in PGY1, the rotations must include 4-month internal medicine, general surgery or orthopaedic surgery, and one or more hospital elective postings required by SMC registration.

Clinical During the inpatient rotations, residents will be involved in the clinical care of medical and surgical inpatients. They are involved with the diagnostic and therapeutic management of these patients, from admission to discharge from hospital. Residents will be assigned to clinical teams supervised by specialists. The specialist assigned to the team interacts daily with the residents during daily rounds, morning reports and supervises and evaluates the resident. Evaluations are completed every month and at the end of each rotation. Residents will be required to perform the following procedures

Procedure Assessment of competence a. Advanced Cardiac Life Support Certification

b. Drawing Venous Blood Direct observation c. Drawing Arterial Blood Direct observation d. Electrocardiogram Direct observation

e. Lumbar Puncture Direct observation f. Nasogastric Intubation Direct observation

g. Placing a Peripheral Venous Line Direct observation Lectures and seminars Introduction to Public Health, Occupational Medicine and General Preventive Medicine a. Overview of contemporary methods and styles of occupational medicine and public health,

appreciation of the breadth of preventive medicine work in Singapore b. For new Residents c. 5 to 8 sessions Preventive Medicine Grand Rounds a. Thematic review of public health and occupational health issues b. Clinical case presentations by residents c. Monthly, 9 sessions a year Seminars and Resident Meetings a. Weekly sessions will be conducted during the Practicum years, incorporating practice-based

learning, small group discussions and seminars on core preventive medicine topics.

Second and Third Years (R2 and R3) (Practicum Years) The second and third residency years are Basic Practicum Years. Residents will be given the opportunity to learn the scope of preventive medicine through broad-based experience. Residents will be rotated to affiliated institutions to gain experience in core areas such as health policy and administration, disease control and epidemiology, health promotion, occupational and environmental health and clinical preventive medicine. The recommended duration of each posting is between 3 to 6 months and should cover different components of the competencies listed above. The actual duration, requirements, and learning


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experience for each posting will be determined by the resident, his supervisor, the respective associate program directors for the posting and the program director.

Residents must perform 9 months of preventive medicine clinical work during their basic practicum years. This can be in the form of full-time clinical preventive medicine postings, or a number of clinic sessions per week that contributes to the 9-month equivalent. This experience is to allow residents to understand issues surrounding clinical preventive medicine, and to apply knowledge and skills learnt during the residency program into clinical practice.

Lectures and seminars Preventive Medicine Grand Rounds a. Thematic review of public health and occupational health issues b. Clinical case presentations by residents c. Monthly, 9 sessions a year d. Compulsory for R2 and R3 Seminars and Resident Meetings a. Weekly sessions will be conducted during the Practicum years, incorporating practice-based

learning, small group discussions and seminars on core preventive medicine topics. b. Compulsory for R2 and R3 Medical Students’ Community Health Projects a. For R2 and R3 b. Field Work and Seminar c. Guide medical students in their community health projects, assist with data collection and

analysis, organize and facilitate seminar for health projects to be presented to faculty. d. Annually, 1 session (either Occupational Medicine or Public Health) Presentation at conference a. Optional for R2; Compulsory for R3 b. National conference (Singapore Public Health and Occupational Medicine Conference) c. Oral presentation of a completed research project to faculty and national scientific audience d. Annually, 1 session (either Occupational Medicine or Public Health)

NUS MPH Core Modules All residents will undertake the core modules (CO5102, CO5103, CO5104, CO5202, CO5203) of the Master of Public Health (MPH) program offered by the Saw Swee Hock School of Public Health at the National University of Singapore. The core modules are offered during Semester 1 from August to December. It is recommended to complete CO5102 and CO5103 in the first year and the other core modules (CO5104, CO5202, CO5203) in the second year. Format includes lectures, case studies, workshops, discussions, and resident presentations. All core modules will have to be completed by end of Year-3. Duration : Up to 3 evenings per week during each semester (17 weeks) Description of the MPH Core Modules CO5102 – Principles of Epidemiology This module covers measurement of health and its determinants in populations, from both routine statistics, surveys, cohort studies, case-control studies and clinical trials. Topics include the design and conduct of epidemiologic studies, and mortality and morbidity indices. Illustrates


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and reinforces the principles taught through interactive sessions on selected topics. CO5103 – Quantitative Epidemiologic Methods This module will be integrated with various epidemiological study designs. It will cover descriptive and inferential statistics; and introduce the concepts of multivariate analyses. CO5104 – Health Policy and Systems How do healthcare systems around the world compare? How can their performance be improved? This module examines the goals and processes for healthcare reform, and the relationship between health policy and health systems performance. It explores the roles of government and the private sector in healthcare financing and provision, and familiarizes participants with the approaches and options for ensuring optimal health systems performance - including the judicious use of regulation, provider payment mechanisms, and other financial incentives. Through role play and stakeholder analysis, participants will appreciate the complex political processes involved in healthcare reform. CO5202 – The Environment in Health and Disease This module will provide a basic understanding of the relationship between the environment (including the general environment and workplaces) and health, and how environmental health issues are managed. Global environmental health issues and its management, as well as problems stemming from air, water and ground pollutants, toxic waste and its containment will be discussed. Visits will also be arranged to various relevant agencies and departments in Singapore. CO5203 – Lifestyle and Behaviour in Health and Disease This module introduces the principles of health education, health promotion and behavioural change. It provides students with the principles and skills to address the social, psychologicand environmental factors influencing behaviour and behaviour change. Upon completion of this module, students will be able to apply commonly used theories and models of behavioural change to change behaviour at the individual, group and community level.

Additional Learning Opportunities Beyond the formal residency training program, there are many other opportunities for learning. These include but are not limited to conferences, meetings, seminars, and training courses. Residents are encouraged to seek out these opportunities to broaden their horizons and experiences. Where possible, the program will inform residents when such opportunities arise. Conferences and training courses Residents are encouraged to attend local and overseas scientific conferences and training courses that add to their knowledge and stature as a preventive medicine physician. Residents are also encouraged to present their work at such conferences where the opportunity arises. This provides an invaluable opportunity for residents to network with experts and contributes to their training program. Specifically, residents are strongly encouraged to attend the annual Singapore Public Health and Occupational Medicine conference, which brings together a wide range of public health and occupational medicine practitioners. Research Residents are encouraged to participate and lead research activities during the course of their training. Research is important to enable residents to have a better understanding of the subject areas, to brainstorm problems and solution, and to improve preventive medicine through


Page 23

evidence-based science. Faculty members will guide residents in exploring areas of research that are relevant to their training experience. Teaching Residents are also encouraged to teach and guide their juniors through the program. Additional teaching opportunities may arise including giving talks, lectures, seminars to fellow residents and to external parties. Residents should take this opportunity to share their experiences, and build their knowledge and confidence.


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Evaluation Monitoring and evaluation is one of the most critical aspects of any training program. Evaluation provides residents with adequate feedback on their progress within their residency program, and their strengths, weaknesses, and areas for improvement. This is important to ensure that residents develop within the training framework, and problems and issues can be identified early and addressed accordingly. The evaluation process is interactive and requires the full participation of the resident and evaluators; it is not meant to be a one-way examination of the resident. Residents will be assessed using objective methods and multiple evaluators on the following 6 ACGME-I general competency areas. These general competency areas will be assessed together with the preventive medicine competencies listed above which residents will have to meet.

1. Interpersonal and communication skills 2. Medical knowledge 3. Patient care 4. Practice-based learning and improvement 5. Professionalism 6. Systems based practice

The resident’s progression in performance appropriate to educational level (residency year of training) will be monitored by the resident and the evaluators. The “Progression of competencies from R1 to R3” lists the requirements within each general competency for each residency year that will be evaluated.

Evaluators and Assessment Methods Residents will be evaluated by a variety of individuals who come into contact with them during the training process. This will ensure that the evaluation is complete, fair, and provides ample feedback to residents to gauge their progress and to identify areas of improvement. Evaluators include the Program Director, faculty supervisor, faculty members, peers, the Clinical Competency Committee, and other individuals that the resident comes into contact with such as clinical tutors, allied health professionals, clerical staff, junior residents, and administrators. The following table provides a summary of the assessment methods and evaluators for each general competency. Details of the different assessment forms are found in the Annexes.

Competency

Assessment Method Evaluator(s)

Interpersonal and Communication Skill

Direct observation Program Director Faculty Member Faculty Supervisor

Multisource Assessment Allied health Professional Clerical Staff Faculty Supervisor Junior Resident Peers Others

Objective structured clinical examination

Clinical Competency Committee Faculty Supervisor Program Director


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Medical Knowledge In-house written examination Faculty Member Faculty Supervisor

Project assessment Clinical Competency Committee Faculty Supervisor Program Director Self

Patient Care Objective structured clinical examination

Consultants Clinical Competency Committee Faculty Member Faculty Supervisor

Standardized patient examination

Consultants Clinical Competency Committee Faculty Member Faculty Supervisor Self

Practice-based Learning and Improvement

In-house written examination Faculty Supervisor Oral exam Clinical Competency

Committee Program Director


Professionalism Multisource Assessment Allied health Professional Faculty Supervisor Junior Resident Peers Other

Systems-based Practice Global assessment Faculty Supervisor Self


Structured case discussions Portfolios

Faculty Member Faculty Supervisor


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Evaluation schedule and documentation The Program Director and the Clinical Competency Committee (CCC) will review each resident’s performance and progress on a semi-annual basis. They will review the resident’s transcripts from written examinations, self-reflection forms and self-assessed competency checklists from his portfolio, evaluation forms completed by faculty, and professionalism assessments completed by multiple evaluators. The Program Director and his CCC will meet the residents one to one in person, and corrections and explanations made as required. For residents who do not perform satisfactorily, remedial plans and advancement criteria from one year of training to the next will be put in place and conveyed to the resident. The resident has the opportunity to indicate disagreement with the evaluation on the evaluation form, and to prepare a written addendum which is attached to the evaluation. A summative evaluation of the residents will also be conducted on his completion of his resident training program. The Program Director will maintain a file that documents the qualifications and progress of each resident. A written summary of meetings with program director, faculty, and supervisor will be entered into the resident's training file. The written final evaluation copy for each resident who completes the program is signed by the Program Director and the resident and placed in the resident’s file.

Final summative evaluation A summative evaluation of residents, documenting performance during the final period of education and verifying that the resident has demonstrated sufficient competence will be carried out at the end of the program. Residents’ Feedback Correspondingly, residents will be asked to provide annual confidential written evaluations of the teaching faculty. This will ensure that the conduct of the Preventive Medicine Residency Program is of the highest standard, and meets the needs of individual residents. It also provides feedback to teaching faculty on their strengths, weaknesses, and areas for improvement. To ensure that resident feedback of the teaching faculty is delivered in the most appropriate and effective manner, residents will also be trained on how to give feedback. To protect the residents’ anonymity, their names will not be recorded in the feedback forms. Aggregate data rather than individual feedback of the rating of the different postings will be provided to the faculty members.

Clinical Competency Committee The CCC is chaired by Dr Chew Ling. It is in-charge of monitoring resident performance and making appropriate disciplinary decisions and recommendations to the Program Director. At all times, the procedures and policies of the CCC will comply with those of the NUHS Graduate Medical Education Committee (GMEC).


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Program Evaluation Committee The Program Evaluation Committee (PEC) is chaired by Prof Goh Kee Tai. There will be one resident representative in the PEC. The role of the PEC is in:

a) planning, developing, implementing and evaluating all significant activities of the residency program;

b) developing competency-based curriculum goals and objectives; c) reviewing annually the program; d) assuring that areas of non-compliance with ACGME-I standard are corrected.

Annual Review of the Program The PEC will undertake a formal, systematic evaluation of the curriculum at least once a year in the following areas:

a) resident performance; b) faculty development; c) graduate performance, including performance of program graduates taking the

certification examination; and d) program quality.


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Resident’s Responsibilities These set of guidelines are to assist residents in successfully completing their Preventive Medicine Residency Program, and to build a collegiate environment between faculty, residents, and other professionals during the course of the residents’ training. Residents are required to: 1. Meet all the expectations and milestones of the Preventive Medicine Residency Program as

stipulated by the NUHS, ACGME-I, MOH Residency Advisory Committee, and laid out in this handbook and elsewhere. Any clarifications about the program should be made in advance to the Program Administration, supervisors, respective Associate Program Directors, or the Program Director. Failure to meet the expectations or milestones may result in the resident being removed from the program.

2. Attend all prescribed lectures, practice-based learning, small group discussions, seminars and other compulsory professional activities organized by NUHS as part of the residency program. These activities will be placed on the program website and e-mailed to residents. a) It is the responsibility of the resident to keep up to date with scheduled activities and of

any changes and updates. b) Residents are required to complete readings or prescribed assignments before these

activities so as to be able to contribute effectively during these sessions. c) Attendance will be taken at these activities d) Residents who are unable to attend these activities should inform the Program

Administration ahead of time. Waivers of attendance will be given under special circumstances at the discretion of the Program Director.

3. Complete and pass any relevant assignments and examinations during the program. These

include the compulsory core modules conducted by NUHS.

4. Maintain an updated logbook for the activities during the program. The logbook will be given to all residents at the start of the residency program, and should be reviewed periodically with the supervisor.

5. Maintain regular communication with the Program Administration, supervisors, respective Associate Program Directors, and the Program Director. Residents should meet their supervisors at least once a week on average to ensure that constant professional linkages are maintained, progress is closely monitored, and feedback is provided. This will ensure that any deviation from the program’s objectives is detected early and corrected, and residents will be able to achieve their educational objectives.

6. Attend professional networking activities with residents and faculty to build a collegiate

environment which is critical for their future work in preventive medicine. 7. Show professional and personal respect to their fellow residents who are colleagues with a

common interest, to faculty members who are giving their time and effort to provide the best training experience, and to patients and the general public.

8. Strive to achieve excellence in their work, and to maintain the integrity of the Preventive

Medicine Residency Program.


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ACGME-I Program Requirements The ACGME-I general guidelines and Preventive Medicine Residency Program requirements can be found in www.acgme-i.org. It comprises of:

a) ACGME-International Specialty Program Requirements for Graduate Medical in Preventive Medicine

b) Preventive Medicine Singapore Addendum a. Annex 1 – Basic practicum phase requirements b. Annex 2 – Advanced practicum phase requirements


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Policies NUHS Policies An Institution Requirement document will be provided to the residents, which includes the policies and practices of NUHS. Participating Institution Policies Residents working in the respective participating institutions are required to adhere to the local policies governing these institutions. Residents should inquire about these requirements through the respective participating institutions and Associate Program Directors.

Graduate Medical Education Committee (GMEC) The NUHS GMEC, which is led by the Designated Institutional Official (DIO), forms an administrative system that oversees ACGME-accredited programs of the sponsoring institution. Voting membership on the committee includes the DIO, Associate DIO, Program Directors, residents, administrators, and others as deemed necessary by DIO appointment. The Chair of the GMEC may form subcommittees based on the need to address specific issues relating to graduate medical education. The composition of such subcommittees may include members of the GMEC and/or non-members with expertise in the area under consideration. The GMEC meets on a monthly basis, and minutes and detailed records are kept of each meeting and are available for inspection by accreditation personnel.


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Photos of Outward Bound Singapore – 24-25 April 2010 )

Left-Right : DIO A/Prof Shirley Ooi, CEO Joe Sim, Dr Tan Xin Quan, PD Prof David Koh, Dr Jake Goh, CMB A/Prof Aymeric Lim

ACGME-I Site Visit on 29 October 2010 From Left: Dr Chew Ling, Dr Tina Foster (Site Visitor), Prof David Koh, Prof Goh Kee Tai, Dr Matthias Toh, A/Prof Shirley Ooi


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Preventive Medicine residency Retreat on 15 January 2011 at Resorts World Sentosa. From Left: Kenny Chiw, Dr Matthias Toh (APD, NHG), Dr Benjamin Ng (APD, TTSH), Dr Tan Xin Quan (Resident), Dr Judy Sng (APD, NUHS), Prof Koh (PD), Dr Alexander Gorny (Resident),

Program study trip to Malaka Mahkota Hospital 0n 17 February 2012. From Right-Back: Dr Jason Yap, Dr Benjamin Ng, Dr Eugene Shum, Dr Chew Ling, Dr Goh Jit Khong, Dr Ho Sweet Far, Dr Jeff Hwang, Dr Joshua Wong and Dr Matthias Toh From Right-Front: Dr Fong Yuke Tien, Dr Olivia Teo, Dr Adelina Shuan Young, Dr Tan Xin Quan, Dr Todd On, Miss Young, Mr Kenny Chiw


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10th Public Health and Occupational Medicine Conference on 25 August 2011 at Furama Waterfont Hotel. Front-Row(Seated) From Right- Dr Matthias Toh, Dr Eugene Shum, Prof David Koh and Dr Fong Yuke Tien 2nd Row (Standing) From Right – Prof Goh Kee Tai, Dr Benjamin Ng, Dr Gan Siok Lin, Dr Adeline Shuan Young, Dr Winston Chin, Dr Todd On and Mr Kenny Chiw 3rd Row (Standing) From Right- Dr Raymond Lim, Dr Jason Yap, Dr Joshua Wong, Dr Hanley Ho, Dr Rachna Bajaj, Dr Tan Xin Quan.

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RESIDENT EVALUATION FORM

- End of Rotation -

Name of Doctor: _____________________________ MCR: __________ Trainee/Resident Year: __________________________________ (if relevant) Name of Evaluator: ___________________________ MCR: ___________ Period of Evaluation: __________________ Date of Evaluation: ____________ Posting / rotation : ______________________________

PART I: COMPETENCY EVALUATION Instructions on Use of Rating Scale:

Circle a number from 1-9 or indicate under the comment section: N.A. (not applicable) if behaviour does not apply to the doctor; N.O. (Not Observed) if the behaviour was

not observed during the period under evaluation. Ratings on a doctor’s attainment of competencies are based on what is expected of his/her cohort.

Superior All behaviours performed very well (ratings 7, 8, or 9)

Satisfactory Most behaviours performed acceptably (ratings 4, 5, or 6); satisfactory performance is described below

Unsatisfactory Several behaviour performed poorly or missed (ratings 1, 2, or 3)

Professionalism Unsatisfactory Satisfactory Superior Comment 1 2 3 4 5 6 7 8 9 1. Accepts responsibility and follows through on tasks

Does so willingly; industrious; complete tasks carefully and thoroughly.

1 2 3 4 5 6 7 8 9 2. Responds to patient’s unique characteristics and needs equitably Provides equitable care regardless of patient culture, disability or socioeconomic status.

1 2 3 4 5 6 7 8 9 3. Demonstrates integrity and ethical behaviour Patient before self; addresses ethical dilemmas; takes responsibility for actions.

Interpersonal & Communication Skills 1 2 3 4 5 6 7 8 9 4. Demonstrates care and concern for the patient/family

Establishes rapport; respectful and compassionate.

1 2 3 4 5 6 7 8 9 5. Communicates effectively with patient/family Good verbal & non-verbal skills; involves patient or family in decision-making.

1 2 3 4 5 6 7 8 9 6. Communicates and works effectively with other healthcare professionals Good medical records, summaries & referrals; considerate to other healthcare professionals.

Medical Knowledge 1 2 3 4 5 6 7 8 9 7. Demonstrates good basic science knowledge

Intelligently discuss pathophysiology and basic sciences within his/her level.

1 2 3 4 5 6 7 8 9 8. Ability to apply knowledge in the clinical context Intelligently discuss diagnosis, evaluation and treatments within his/her level.

1 2 3 4 5 6 7 8 9 9. Demonstrates up-to-date knowledge Cites recent literature when appropriate, ask well-informed and knowledgeable questions.

1 2 3 4 5 6 7 8 9 10. Demonstrates good analytical thinking and problem solving techniques Demonstrates good analytical approach and problem solving techniques in a medical setting.

Practice-Based Learning & Improvement 1 2 3 4 5 6 7 8 9 11. Understands and integrates concepts of quality

improvement into practice Systematically review outcomes; reflects to identify strengths and weaknesses; improves.

1 2 3 4 5 6 7 8 9 12. Engages in on-going learning Does extra reading and surgical /procedural practice when needed; uses IT to aid learning.

1 2 3 4 5 6 7 8 9 13. Facilitates the learning of others Teaches/coaches junior colleagues and students; directs learners to relevant resources.

Patient Care 1 2 3 4 5 6 7 8 9 14. Demonstrates comprehensive assessment to reach

appropriate diagnosis Thorough history, physical exams, investigations and appropriate diagnosis

1 2 3 4 5 6 7 8 9 15. Provides the appropriate ongoing management based on best clinical practice Synthesize and implement treatment plans using evidence-based medicine, protocols and specialist inputs.

1 2 3 4 5 6 7 8 9 16. Responds appropriately to emergency clinical problems Initiates appropriate care and procedures in emergencies as part of team.

1 2 3 4 5 6 7 8 9 17. Demonstrates procedural skills appropriate to level of training Demonstrates knowledge of indications and risks; technical ability; minimizes patient discomfort.

1 2 3 4 5 6 7 8 9 18. Practices within the scope of his/her abilities. Makes correct judgement to consult and/or ask for help when needed.

Systems-based Practice 1 2 3 4 5 6 7 8 9 19. Provides cost-conscious medical care

Considers costs/benefits of care; adheres to pathways; does not order unnecessary tests.

1 2 3 4 5 6 7 8 9 20. Works to promote patient safety Identifies system causes of medical error; adheres to patient safety protocols.

1 2 3 4 5 6 7 8 9 21. Coordinates care with providers in the larger healthcare community Provides care options; makes appropriate referrals; assists with arrangement and follow-up.

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If there are areas of deficiencies, has trainee been made aware of them � Yes � No � NA

Signature of Assessor: ______________________

Date: ____________________

PART II: ADDITIONAL COMMENTS Particular areas of excellence/deficiencies to highlight (if any):

Any other comments:

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NUHS Residency Program

MULTI-SOURCE FEEDBACK (MSF) ASSESSMENT (MEDICAL STAFF) Resident Name: Rotation: Residency Year:

Evaluator Name: Date: 1 / 2 / 3 / 4 / 5

You have been nominated to act as a Referee for the doctor named above. Please give your honest assessment about him/her. All information will be kept confidential and will only be used for appraisal for that doctor. For each item, please circle the number that corresponds with how characteristic the behavior is of the resident you are evaluating. Please note that your scoring should reflect the performance of the trainee against that which you would reasonably expect at their stage of training. If you score 1 or 2, please give a brief example in the comments box. Please add any other opinions about this doctor’s strengths and weaknesses.

Not at all

Characteristic

Highly Characteristic

Don’t Know

Professionalism

1. Empathy and respect: Is polite, considerate and respectful of patients and colleagues at all levels; compassion and empathy towards patients and relatives

1 2 3 4 5 N/A

2. Conscientious, reliable and punctual; available for advice and help when needed; completes tasks reliably and on time

1 2 3 4 5 N/A

3. Honesty and Integrity 1 2 3 4 5 N/A 4. Takes responsibility for own actions and

actions of the team 1 2 3 4 5 N/A


5. Communicates sensitively and effectively with healthcare professionals

1 2 3 4 5 N/A

6. Communicates sensitively and effectively with patients and families

1 2 3 4 5 N/A

Clinical Assessment

7. Diagnostic skill, appropriate ordering of investigations

1 2 3 4 5 N/A

Patient management

8. Management of complex clinical problems; appropriate use of resources

1 2 3 4 5 N/A

Personal Development

9. Commitment to improving quality of service; keeps up-to-date with knowledge and skills

1 2 3 4 5 N/A

Teaching and Training 10. Contributes to the education and supervision of

students and junior colleagues 1 2 3 4 5 N/A

Team player skills

11. Good team player; supportive and accepts appropriate responsibility; approachable

1 2 3 4 5 N/A

Leadership

12. Takes leadership role when circumstances require; delegates appropriately

1 2 3 4 5 N/A

Overall Effectiveness as a Clinician

13. Plans course of care effectively, anticipates post-discharge needs

1 2 3 4 5 N/A

Overall Professional Competence

14. Overall Professional Competence 1 2 3 4 5 N/A

COMMENTS ABOUT THE DOCTOR Y Your name and signature: ________________________________________


MULTI-SOURCE FEEDBACK (MSF) ASSESSMENT (ALLIED HEALTH) Resident Name: Rotation: Residency Year:

Evaluator Name: Date: 1 / 2 / 3 / 4 / 5

You have been nominated to act as a Referee for the doctor named above. Please give your honest assessment about him/her. All information will be kept confidential and will only be used for appraisal for that doctor. For each item, please circle the number that corresponds with how characteristic the behavior is of the resident you are evaluating. Please note that your scoring should reflect the performance of the trainee against that which you would reasonably expect at their stage of training. If you score 1 or 2, please give a brief example in the comments box. Please add any other opinions about this doctor’s strengths and weaknesses.

Not at all

Characteristic

Highly Characteristic

Don’t Know

Professionalism

1. Follows through on tasks he/she agreed to perform

1 2 3 4 5 N/A

2. Responds to requests, including pages, in a helpful and prompt manner

1 2 3 4 5 N/A

3. Knows the limits of his/her abilities and asks for help when needed

1 2 3 4 5 N/A

4. Takes responsibilities for actions, admits mistakes and does not blame others

1 2 3 4 5 N/A

5. Makes patient care and well-being a priority 1 2 3 4 5 N/A

6. Provides equitable care regardless of patient culture and socioeconomic status

1 2 3 4 5 N/A

7. Is willing to act on feedback or other information to improve patient care

1 2 3 4 5 N/A

8. Maintains respectful demeanor in demanding and stressful situations

1 2 3 4 5 N/A

9. Is honest in interactions with others 1 2 3 4 5 N/A

10. Takes on extra responsibilities when the need arises

1 2 3 4 5 N/A


11. Easily establishes rapport with patients and their families

1 2 3 4 5 N/A

12. Is respectful and considerate in interactions with patients

1 2 3 4 5 N/A

13. Responds to patients’ needs, feelings, or wishes

1 2 3 4 5 N/A

14. Uses non-technical language when explaining and counseling patients

1 2 3 4 5 N/A

15. Spends adequate amount of time with patients 1 2 3 4 5 N/A

16. Is willing to answer questions and provide explanations

1 2 3 4 5 N/A

17. Is courteous to and considerate to nurses and

other staff 1 2 3 4 5 N/A

18. Discusses patient issues clearly with staff and faculty

1 2 3 4 5 N/A

19. Listens to and considers what others have to say about relevant issues

1 2 3 4 5 N/A

20. Maintains complete and legible medical records

1 2 3 4 5 N/A

COMMENTS ABOUT THE DOCTOR Y Your name and signature: ________________________________________

NUHS Residency Program Learning Evaluation Document

Resident's Name : _______________________ Date: _______________ Year of training : _______________________ Description of learning activity

Cased based discussion

Evidence Based Journal Club

Patient safety / error/ complaint

Audit

Reflective diary

Teaching students/ junior residents

Others : ___________________________

Scenario

Type details of case or relevant scenario here

What I have learnt from this?

Type what you learnt here

What would I do differently in future?

Tutor's comments (include 1-2 things the trainee did well, and 1-2 things that the trainee can improve on or think about)

Trainee's overall performance in this learning activity:

Good Satisfactory Needs improvement

Competencies covered in this exercise: (check all that apply)

Patient Care Medical Knowledge Communication skills

Professionalism Practice Based Learning Systems-based practice

Name of Faculty: __________________________ Date: _____________

Revised as at 220710


Mini-Clinical Evaluation Exercise (Mini-CEX) Standardized Direct Observed Patient Encounter Assessment Tool

Resident's Name : _______________________ Date: ______________ Year of Training : _______________________

Clinical setting : EMD Ambulatory In-patient

Acute Admission

Focus of encounter : History Diagnosis Management

Counseling/ Education Communication Problem solving

Complexity of case : Low Average High

Assessor : Senior consultant Consultant Assoc Consultant Registrar

Please rate the following areas (9 point scale)

1. History Taking ( Not observed)

Efficiently gathers essential and accurate information from all available sources.

1 2 3 4 5 6 7 8 9

UNSATISFACTORY SATISFACTORY SUPERIOR

2. Communications Skills ( Not observed)

Greets patient, sets agenda, uses open ended questions, responds to patients non-verbal cues, avoids medical jargon. Communicates well with patient / family

1 2 3 4 5 6 7 8 9


3. Physical Examination ( Not observed)

Technically proficient exam maneuvers. Performs all components of the exam, whilst being able to elicit signs relevant to the clinical complaint. Uses exam instruments properly and maintains patient comfort. Good rapport with patient. Washes hands prior to patient contact.

1 2 3 4 5 6 7 8 9



4. Clinical Judgment ( Not observed)

Able to assess the information, identify the problem and prioritize differential diagnosis. Assess severity of disease and urgency of clinical care.

1 2 3 4 5 6 7 8 9


5. Management ( Not observed)

Makes informed diagnostic and treatment decisions using patient information and preferences, clinical judgment, and scientific evidence.

1 2 3 4 5 6 7 8 9


6. Professionalism ( Not observed)

Respectful of patient's privacy and confidentiality. Shows compassion, ethical behaviour.

1 2 3 4 5 6 7 8 9


7. Organisation/ Efficiency ( Not observed)

Good pace of questions, logical flow to medical interview, examination and counseling. Logically organizes data. Uses ancillary staff and resources appropriately. Works to stay on-time when appropriate.

1 2 3 4 5 6 7 8 9


8. Documentation ( Not observed)

Appropriate and accurate documentation in patient records.

1 2 3 4 5 6 7 8 9


9. Overall Clinical Care (Global Score)

1 2 3 4 5 6 7 8 9



Summary Comments (Faculty):

1. What did you observe the resident do well in this patient encounter? (list up to 3)

2. What did you observe the resident do that can be improved? (list up to 3) Agreed Action Plan:

Low High

For resident: How effective was this as a learning exercise? 1 2 3 4 5 6 7 8 9 10

For assessor: How effective was this as a learning exercise?

1 2 3 4 5 6 7 8 9 10

______________________________________ ______________________________

Signature / Name (Faculty) Date

______________________________________ ________________________________

Signature (Resident) Date

Year of Residency : __________________

Date of Review : ____________________________________

By Yes Partial No

A Patient (Population) Care & Medical Knowledge

A1 Clinical Preventive Medicine

A1.1 Recognize that effective and appropriate clinical preventive services

improve health of individuals and populationsR1

A1.2 Recognize ethical, cultural, and social issues related to a particular

issue and developing interventions and programs that acknowledge

and appropriately address the issues

R2

A1.3 Provide clinical preventive medicine, including the ability develop,

deliver, and implement, under supervision, appropriate clinical services

for both individuals and populations, and evaluate the effectiveness of

clinical services for both individuals and populations

R2

A1.4 Provide clinical preventive medicine, including the ability to evaluate

the effectiveness of clinical services for both individuals and

populations

R3

A1.5 Evaluate the effectiveness of appropriate clinical preventive services

for both individuals and populationsR3

A2 Epidemiology

A2.1 Use computers for word processing, reference retrieval R1

A2.2 Recognize outbreak events of public health significance, as they

appear in clinical or consultation settingsR1

A2.3 Conduct program and needs assessments and prioritize activities using

objective, measurable criteria such as epidemiological impact and cost-

effectiveness

R2

A2.4 Use epidemiology and biostatistics, including the ability to characterize

the health of a community and design and conduct an epidemiological

study

R2

A2.5 Use epidemiology and biostatistics, including the ability to design and

operate a surveillance system; select and conduct appropriate

statistical analyses; and design and conduct an outbreak or cluster

investigation

R2

A2.6 Use epidemiology and biostatistics, including the ability to translate

epidemiological findings into a recommendation for a specific

intervention

R3

A2.7 Design and conduct health and clinical outcomes studies R3

A3 Biostatistics

A3.1 Use epidemiology and biostatistics, including the ability to characterize

the health of a community and design and conduct an epidemiological

study

R2

A3.2 Use computers for statistical analysis, graphic display, database

management, and communicationR2

A3.3 Use epidemiology and biostatistics, including the ability to design and

operate a surveillance system; select and conduct appropriate

statistical analyses; and design and conduct an outbreak or cluster

investigation

R2

A3.4 Use epidemiology and biostatistics, including the ability to translate

epidemiological findings into a recommendation for a specific

intervention

R3

A3.5 Design and conduct health and clinical outcomes studies R3

A4 Behavioral Aspects of Health

A4.1 Understand primary, secondary, and tertiary preventive approaches to

individual and population-based disease prevention and health

promotion

R1

A4.2 Describe and analyze the behavioral, political, socio-structural and

environmental influences on health of individuals R1

A4.3 Assess reasons for non-compliance with medications and healthy

lifestyles in patients R1

A4.4 Provide health counseling and health education to individuals to

change risky behaviors e.g. smoking cessation, weight control,

prevention of sexually transmitted infections

R2

A4.5 Design and implement behavioral interventions and clinical preventive

services to promote health and prevent disease at individual, group

and community level

R2

A4.6 Design, implement, monitor and evaluate clinical preventive services,

including disease control and screening programs for individuals and

communities

R3

A4.7 Design, implement, monitor and evaluate community-based

interventions to address risk factors for disease or to promote healthR3

Name of Resident : _________________________________

Period of Review: _______________ to _______________

Preventive Medicine Residency Program - Resident Self Review

Preventive Medicine Competencies Resident Comment (If any)Achieved

Posting(s) in the Review Period : ______________________________________________________________


Date of Review : ____________________________________

By Yes Partial No

Name of Resident : _________________________________





A5 Environmental and Occupational Health

A5.1 Manage the health status of individuals who work in diverse work

settingsR1

A5.2 Mitigate and manage medical problems of workers R1

A5.3 Practice occupational and environmental health, including being able to

assess and respond to individual and population risks for occupational

and environmental disorders

R2

A5.4 Recognize and evaluate potentially hazardous workplace and

environmental conditionsR2

A5.5 Practice occupational and environmental health, including being able to

assess and respond to individual and population risks for occupational

and environmental disorders

R2

A5.6 Assess safe and unsafe work practices and safeguard employees and

others, based on clinic and worksite experienceR2

A5.7 Recommend controls or programs to reduce exposures, and to

enhance the health and productivity of workersR2

A5.8 Report outcome findings of clinical and surveillance evaluations to

affected workers as ethically required; advise management concerning

summary (rather than individual) results or trends of public health

significance

R2

A5.9 Monitor/survey workforces and interpret/monitor surveillance data for

prevention of disease in workplaces and enhancing the health and

productivity of workers

R3

A5.10 Manage worker insurance documentation and paperwork, for work-

related injuries that may arise in numerous work settingsR3

A5.11 Recommend controls or programs to reduce exposures, and to

enhance the health and productivity of workersR3

A6 Health Services Administration

A6.1 Identify and review relevant laws and regulations germane to the

resident’s specialty area and assignmentsR1

A6.2 Identify organizational decision-making structures, stakeholders, style,

and processesR2

A6.3 Manage and administer, including the ability to assess data and

formulate policy for a given health issue and develop and implement a

plan to address a specific health problem

R2

A6.4 Manage and administer, including the ability to conduct an evaluation

or quality assessment based on process and outcome performance

measures; and manage the human and financial resources for the

operation of a program or project

R3

B Practice-Based Learning and Improvement

B1 Identify strengths, deficiencies, and limits in one’s knowledge and

expertiseR1

B2 Set learning and improvement goals R1

B3 Identify and perform appropriate learning activities R1

B4 Incorporate formative evaluation feedback into daily practice R1

B5 Locate, appraise, and assimilate evidence from scientific studies

related to their patients’ health problemsR1

B6 Use information technology to optimize learning R1

B7 Participate in the education of patients, families, students, residents

and other health professionalsR1

B8 Communicate effectively with patients, families, and the public, as

appropriate, across a broad range of socioeconomic and cultural

backgrounds

R1

B9 Systematically analyze practice using quality improvement methods,

and implement changes with the goal of practice improvementR2

B10 Systematically analyze practice using advanced quality improvement

methods, and implement changes with the goal of practice

improvement

R3

C Interpersonal and Communication Skills

C1 Communicate effectively with physicians, other health professionals,

and health related agenciesR1

C2 Maintain comprehensive, timely, and legible medical records R1

C3 Work effectively as a member of a health care team or other

professional groupR1

C4 Work effectively as a leader of a health care team or other professional

groupR2

C5 Act in a consultative role to other physicians and health professionals R3


Date of Review : ____________________________________

By Yes Partial No

Name of Resident : _________________________________





D Professionalism

D1 Compassion, integrity, and respect for others R1

D2 Responsiveness to patient needs that supersedes self-interest R1

D3 Respect for patient privacy and autonomy R1

D4 Accountability to patients, society and the profession R1

D5 Sensitivity to a diverse patient population, including but not limited to

diversity in gender, age, culture, race, religion, disabilities, and sexual

orientation

R1

D6 Responsiveness to a diverse patient population, including but not

limited to diversity in gender, age, culture, race, religion, disabilities,

and sexual orientation

R2

E Systems-based Practice

E1 Work effectively in various health care delivery settings and systems

relevant to their clinical specialtyR1

E2 Coordinate patient care within the health care system relevant to their

clinical specialtyR1

E3 Incorporate considerations of cost awareness and risk-benefit analysis

in patient and/or population-based care as appropriateR1

E4 Advocate for quality patient care and optimal patient care systems R1

E5 Work in inter-professional teams to enhance patient safety R1

E6 Participate in identifying system errors R1




E9 Improve patient care quality R2

E10 Implement potential systems solutions R2




A) Proportion (%) of learning targets met? _______ / 72 = _______% R1

R2

R3

Total

B) Reasons for not meeting targets :

�Targets for next Evaluation Period: ________________ to ________________ Residency Year : _____

A) Performance Targets :

B) Learning Targets :

1 *Forms could be (a)360 degree evaluation form; (b) End of posting evaluation form; (c) end of rotation form; (d) Learning Evaluation form; (e) MOH C1 form.

PREVENTIVE MEDICINE RESIDENCY PROGRAMME

COMPETENCY EVALUATION

Name of Resident _____________________________________________________

Period of Review _____________________________________________________

Year of Residency (check one) R1 R2_____ R3___________________

Training Site in Review Period ______ _______________

Posting in Review Period ______________________________________________

Preceptor (name & sign) Date of review ___________________

Check One: Initial Chart Mid-Year Chart End-Year Chart

I. PATIENT (POPULATION) CARE Residents must demonstrate knowledge of direct patient (population) care for the provision of preventive, diagnostic, and therapeutic interventions to patients (populations).

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II. MEDICAL KNOWLEDGE Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents must demonstrate knowledge of

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III. PRACTICE-BASED LEARNING AND IMPROVEMENT Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals,

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IV. Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:

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V. Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

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VI. System-based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

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